by Elizabeth H. Lin, MD, MPH, Group Health Physician and adjunct investigator at Group Health Research Institute (GHRI); and Kim I. Holland, MD, Group Health Physician

All women may face life challenges like changing physical capability, caregiver responsibilities, financial instability, and family disintegration. Moreover, women of color may face these challenges with disproportionately worse outcomes. And women of color face these challenges in an increasingly virulent environment, with grief and loss due to drug- and alcohol-related violence on one side and racism and feared or actual loss of loved ones from police violence on the other.

Mindfulness holds promise for helping women of color who have chronic disease. Yet the cost of an eight-week mindfulness-based stress reduction (MBSR) course can be prohibitive, especially for this population. That’s why we decided to volunteer our efforts and expertise to offer this MBSR pilot, with encouragement from Stephen Tarnoff, MD, Group Health Physicians president and CEO, and support from our Rainier Medical Center colleagues.

“Kim was the inspiration for developing this course. As an African American woman physician, she provided crucial input that helped me to understand more deeply the perspectives, and experiences, values, and culture of women of African American descent. These important perspectives guided me to communicate with more trust and connection.”

— Dr. Lin

Mindfulness-based stress reduction (MBSR) trains people to bring their attention to the internal and external experiences happening in the present moment. Research has shown MBSR can improve mood, resilience, well-being, and immunity. It has also been shown to reduce stress, anxiety, sleep problems, and chronic pain — including back pain, in a recent GHRI study.

“Elizabeth has been meditating daily for 25 years, and she has trained with many founders of mindfulness programs. After I participated in her prior MBSR classes — and being familiar with her mind-body research and clinical work on chronic illness and depression — I became acutely aware of the unmet need in my practice for accessible treatment options to address the stress and trauma of everyday living with chronic illness and cancer at reasonable cost.

“I trusted Elizabeth with the care and teaching of my patients. I approached her and the leaders and staff at Rainier Medical Center, the participants in Rainier Walk and Talk, and the Cierra Sisters, Inc. (an African American breast cancer survivor and support organization) with the idea of grassroots effort to launch a class in MBSR for women of color with cancer and other chronic diseases in Rainier Valley. I’ve been heartened by their outpouring of support — and the spread outside our clinic to include participants from outside of Group Health medical centers has been quite heartening.”

— Dr. Holland

We had planned for only around 10 women, but the need was greater. The class filled up quickly, with 25 registered participants and four waitlisted. At the first day of class, 30 women showed up, including five who were neither registered nor waitlisted. We allowed them to continue the course. We had a very hard time turning people away. The nominal fee and availability of ample scholarships very likely play a significant role in the enthusiastic response we have received in number of attendees.

“Kim brings a foundation of trust, good will, and caring that has been unparalleled in my prior classes. She has encouraged women from her Group Health practice and many communities for women of color from the larger Seattle area to take this course. Being the primary care physician for many participants, she has also known many of the women through her participation in many communities of color.”

— Dr. Lin

The class’ larger size contributes to its richness. Participants are all women of color — African Americans, Latinas, and Asian Americans — with chronic illnesses. They faced many of the challenges so prevalent in vulnerable populations: chronic pain, hypertension, cancers, obesity, depression, anxiety, insomnia, a variety of trauma, and grief. But their age span is wide, ranging from mid 30s to mid 80s, and they have a wide range of occupations, concerns, and resources.

Joys, sorrows, and snacks

It’s been a delight to see how eager the participants are to learn and to experience deeply whatever happens to surface for them: both the joys and sorrows. Many are experiencing life more fully — and still holding it altogether. The participants are quite engaged. The group has a strong sense of community, with mutual support. Participants voluntarily bring in delicious and exotic snacks.

About 70 percent to 90 percent of the women are present at each class. Some of the barriers to regular participation have been the difficulty for women with disability such as stroke to participate in a class held at night, fatigue after working a full 8-hour day, and acute illnesses.

Many participants do their home practices diligently, and they contribute touching observations on how the practices are changing how they respond to challenges and stresses in their daily lives. For example, on the evening after the recent presidential election, participants gave moving accounts of how their mindfulness practices helped them manage a flood of negative emotions.

Interestingly, many of the participants are devout Christians, yet they are open and receptive to learning a variety of contemplative practices and meditation. Although rooted in Buddhist meditation, MBSR is secular.

Going forward

We asked women participating in this first pilot class to commit to passing on what they are learning at home and in their respective communities. We have begun to hear stories of others who have started to pause and practice mindfulness in their day after seeing what is happening for their friend or loved one. The group has decided to do monthly follow-up sessions led by participants.

We now have a waitlist of about 20 women who are interested in another course, if offered. But we’re uncertain of how this will proceed. We lack resources for another class. We hope that this pilot will help pave the way for additional classes on evidence-based mindfulness and compassion classes to serve the Group Health and greater Seattle community.

It takes a village, and our special thanks go out to Cynthia Humphrey, Tina Asiimwe, Betty Wills, MA, Cathy Kawamoto, Maggie Cooper, Elaina Kook, and Leslie Gilbert, RVM — and to Pat Boiko, MD, and the staff at Carolyn Downs Family Medical Center as well as Richard Kovar, MD, of Country Doctor Community Health Centers.